I hate being told what to do and usually I will do the opposite. So where on earth did I get the belief that I know what is right and that I must make sure I tell everyone what to do to stay healthy?
A tool kit for the diabetic foot
Diabetes clinics form a major part of the workload for practice nurses, but 95% of routine diabetes care is delivered by patients themselves or by family members and carers. It is imperative that we offer people with diabetes concise, up-to-date education for effective foot care and to prevent complications.
Updated NICE CKD guidelines: What they mean for your practice
Since the publication in 2008 of the first NICE guideline on the diagnosis and management of chronic kidney disease (CKD), there has been concern that creatinine-based estimated glomerular filtration rate (eGFR) may not accurately identify people at increased risk–particularly in elderly populations. The updated NICE guideline, issued in July 2014, includes some important changes that take into account recent research into the prognosis of CKD. Of particular relevance for GPs are changes to the diagnostic criteria and classification of CKD, which are described in this article.
Why we need a new approach to managing people with frailty
Frailty is a distinctive health state related to the ageing process in which multiple body systems gradually lose their in-built reserves. This means the person is vulnerable to dramatic, sudden changes in health triggered by seemingly small events such as a minor infection or a change in medication.
Understanding frailty as a long-term condition
Acommonly heard clinical expression is “He/she is very frail”. It provides a summary statement of an older person that implies concerns over vulnerability and prognosis. This is how we have conventionally considered frailty—as a descriptive label: ‘the frail elderly’. In this article, we will re-frame frailty in a potentially more helpful way. We will examine frailty from the perspective of an abnormal health state that behaves just like a long-term condition. This conceptualisation of frailty opens up new approaches to helping people who are frail.
Improving end-of-life care in the community
Most nurses are involved in the care of the 1% of the population currently nearing the end of their lives: that is, people considered to be in their final year, months, weeks or days of life. The Gold Standards Framework (GSF) programmes can help provide a structured framework in this challenging area, leading to more proactive and consistent standards of care, and enabling more people to live well and die well where they choose.
Care and support planning for people with frailty
Supported self-management is feasible and desirable for people with mild frailty, but care and support planning is more appropriate for individuals with moderate frailty. This section considers how the primary healthcare team can apply a whole person and personalised approach to care and support planning.
Supported self-management for people with frailty
The first section of this supplement made the case to consider frailty from the perspective of a long-term condition. This and the next section explore what this means in terms of applying some of the well-developed models for the care of longterm conditions to people who are living with frailty. First, we examine how the highly evidence-based model of supported self-management might be applied to frailty.
Introduction to frailty
Frailty is a distinctive health state related to the ageing process in which multiple body systems gradually lose their in-built reserves. This means the person is vulnerable to dramatic, sudden changes in health triggered by seemingly small events such as a minor infection or a change in medication.
Understanding frailty as a long-term condition
A commonly heard clinical expression is “He/she is very frail”. It provides a summary statement of an older person that implies concerns over vulnerability and prognosis. This is how we have conventionally considered frailty—as a descriptive label: ‘the frail elderly’. In this article, we will re-frame frailty in a potentially more helpful way. We will examine frailty from the perspective of an abnormal health state that behaves just like a long-term condition. This conceptualisation of frailty opens up new approaches to helping people who are frail.
Blood pressure: A call to action for primary care
Over the next 10 years, an estimated 45,000 quality-adjusted life-years and £850m health and social care costs could be saved, if England saw a 5 mmHg reduction in the average population systolic blood pressure. In addition, substantial reductions in death and disability could be achieved if there was a step change in our approach to detection and treatment of hypertension. This is the rationale behind the Blood Pressure Action Plan that was published recently.
NICE Guidelines: A changing approach to atrial fibrillation
Atrial fibrillation (AF) is the commonest cardiac arrhythmia seen in primary care and, if left untreated, is a significant risk factor for stroke. New guidelines from the National Institute for Health and Care Excellence (NICE) include some practice-changing recommendations on diagnosing AF, the role of aspirin and the novel oral anticoagulants (NOACs), and shared decision-making to ensure patient-centred care.
